# LONGEVITY WEIGHT MANAGEMENT CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1588568505
- **Authorized official:** NATALIE LOUISE IKEMAN PA-C (CEO)
- **Authorized official phone:** (612) 327-2228

## Contact information

- **Practice address:** 16273 BAYWOOD LANE, EDEN PRAIRIE, MN 55346-4302
- **Practice address phone:** (612) 327-2228
- **Mailing address:** 16526 W 78TH ST STE 188, EDEN PRAIRIE, MN 55346-4302
- **Mailing address phone:** (612) 327-2228

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QB0002X | Obesity Medicine (Family Medicine) Physician | — | NULL | Yes |

## Other

- **Enumeration date:** 10/05/2026
- **Last updated:** 10/05/2026